vnrs b50a-advanced pharmacology part a

VNRS B50A-ADVANCED PHARMACOLOGY PART A

Stephanie Engler, RNMonday 1:15-2:[email protected]

WELCOME TO PHARMACOLOGY!

• Syllabus• Content is board approved- some

review, but we will be digging deeper!• Expectations from this class….

• Please do your homework• Be ready to participate in class• Please bring 3 scantrons to class

• How can I help you succeed???

TO BE SUCCESSFUL IN THIS CLASS………

• Come to class with homework prep questions answered- find on website

• Bring lecture notes to class- print from website

• Bring a blank concept map to class for additional note taking

• Study from your lecture notes and additional notes in class- use your text book for clarification of material covered

• Participate in group “round tables” when available- good time to review exams and ask questions

LET’S GET STARTED…………

Unit 1- Introduction•See class handout

Unit 2- Medications Administered for Gastrointestinal Disorders•GI review-http://www.youtube.com/watch?v=Z7xKYNz9AS0&feature=fvsr •Liver disease, Pancreatitis & Insulin notes•Groups- answer discussion ?’s

GI MEDS AND PLAN OF CARE

PLAN FOR THE DAY:

• Quick Notes Review

• Case Study

• NCLEX Questions

GASTRIC ACIDSystem•Esophagus•Stomach•Liver/gallbladder•Pancreas•Small/large intestine

Gastric acid production•Parietal cells- H+ production•Receptors- histamine2

Function•Stomach pH 1-4•Digestion•Defense against infection

WHAT DO WE DO WITH THE OVERPRODUCTION OF THIS ACID????

****Give antacids= to neutralize!•Milk of Magnesia (magnesium hydroxide)•TUMS (calcium carbonate)Heartburn, gastritis, peptic ulcer disease (PUD)

****Suppress gastric acid!H2 receptor blockers- bind to H2 receptor•Pepcid (famotidine)•Decrease HCl acid production•Decrease heartburnGERD, erosive esophagitis, PUD, H. pylori, gastritis, prevent stress ulcers

Gastric barrier- adheres to gastric mucosa/ binds to ulcer•Carafate (sucralfate)Decrease heartburn

•http://www.youtube.com/watch?v=_fa60VhclNo&feature=related

WHAT DO WE DO WITH THE OVERPRODUCTION OF THIS ACID????

****Suppress gastric acid!

Proton pump inhibitors (PPI)- blocks proton pump, stops HCl production•Prevacid (lansoprazole)•Prilosec (omeprazole)•Protonix (pantoprazole)Decrease HCl production, decrease heartburn•Caution with hepatic disease!!!!

GASTROINTESTINAL CASE STUDYHistory of present illness (HPI):

Mr. D- 70 year old male- enters your clinic with a complaint of severe upper abdominal pain that occurs mostly in the evening hours. It is relieved by food, although he vomits his meals several times each week. Wife states intermittent confusion in last month.

Past medical history (PMH):

He has a history of peptic ulcers and alcohol abuse

Smoking has been reduced to two packs per week

He is taking no drugs, other than Rolaids for his indigestion

Workup: Vital signs- BP- 106/60, HR- 108, RR- 12, Temp- 98.6, O2- 98 on 2L NC, 2/10 pain

GASTROINTESTINAL CASE STUDY Lab results:

+blood in stoolNa 138K+ 3.2

Glucose 100Ca 8.0BUN 12

Creat 1.2AST 100ALT 150

Albumin 1.8Hgb 10.2Hct 28.6

NCLEX

Which of the following best describes the mechanism of the action of sucralfate (Carafate)?

a.Kill H. pylorib.Reduce the secretion of acidc.Increase the secretion of bicarbonated.Add a gel-like protective mucus over the ulcer

NCLEX

The nurse would administer amoxicillin (Amoxil) or clarithromycin (Biaxin) for peptic ulcers in order to:


NCLEX

Which class of drugs acts by neutralizing stomach acid?

a.H2-receptor blockersb.Serotonin receptor blockersc.Proton-pump inhibitorsd.antacids

NCLEX

Which of the following is the most effective class of drugs used to treat diarrhea?

a.Phenothiazinesb.Antihistaminesc.Anticholinergicsd.Opioids

RESPIRATORY MEDS AND PLAN OF CARE

PLAN FOR THE DAY:

• Respiratory Review (A&P/ Structures)

• Mediators of inflammation

• Respiratory defense mechanisms

• Homework Review


The respiratory system has built-in methods to prevent harmful substances from entering the lungs:

•Your nose moistens and warms the air.•The hair (cilia) in your nose helps filter out large particles.•Mucus produced by cells in the trachea and bronchial tubes keeps air passages moist and aids in trapping dust, bacteria, and other substances.•Cilia in the air passages move in a sweeping motion upwards towards the throat and mouth to get the mucus and bacteria etc out of the lungs.


Mediators of inflammation

1. Bradykinin, complement, prostaglandin.2. Leukotrienes.3. Histamine.4. Mast cells.

Respiratory defense mechanisms

1. Cough. 2. Reflex bronchoconstriction. 3. Filtration, mucociliary response. 4. Alveolar macrophages -Macrophages engulf and digest

foreign materials in a process known as phagocytosis.


Asthma- caused by inflammation in the airways, causes the airways of the lungs to swell and narrow, leading to wheezing, shortness of breath, chest tightness, and coughing.

Chronic obstructive pulmonary disease (COPD)- Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis – chronic•Chronic bronchitis- which involves a long-term cough with mucus•Emphysema- which involves destruction of the lungs over time

Pneumonia- an inflammation of the lungs caused by an infection


• Drugs affecting the respiratory system• Bronchodilators

• Adrenergic agonists- • Proventil (albuterol)- short acting• Xopenex (levalbuterol)- short

acting• Serevent (salmeterol)- long acting

• Leukotriene inhibitors• Anticholinergics

• Decrease Inflammation• Glucocorticoid steroids

• Antihistamines• Decrease secretions

MEDICATIONS FOR THE INTEGUMENTARY SYSTEM

• Burns- see handout

• Eczema- corticoidsteroid creams

• Psoriasis- • corticoidsteroid creams, • topical retinoids (Tazarotene),• Vit D analogues (Dovonex)

PSORIASIS & ECZEMA


Remember to Study:1.Therapeutic Effects2.Side Effects3.Nursing Actions4.Patient Education5.Is this drug short or long acting?6.Know glucocorticoid steroids!• Indications• Precautions• Side effects• Nursing actions• Drugs and their route

NCLEX

Which of the following would the nurse identify as being involved with asthma?

A. Acute infectionB. Hyperactive airwaysC. Alveolar collapseD. Progressive loss of lung compliance

NCLEX

Which term would be used to describe the movement of air in and out of the body?

A.PerfusionB.RespirationC.VentilationD.Gas exchange

NCLEX

Sympathetic nervous system stimulation of the respiratory tract would result in which of the following?

A.Diaphragmatic contractionB.BronchoconstrictionC.Increased respiratory rateD.Inspiratory movement

NCLEX

After reviewing information about respiratory tract disorders, a group of students demonstrate understanding of the material when they identify which of the following as the most common cause of COPD?

A.InfectionB.Allergen exposureC.Genetic inheritanceD.Cigarette smoking

NCLEX

A nurse administers an antitussive agent cautiously to a patient with asthma for which reason?

A.The airway needs to be maintained.B.The drug can lead to addiction.C.A loss of respiratory reserve can occur.D.The patient may experience increased sedation.

NCLEX

Which agent would the nurse instruct a patient to use orally?

A.PseudoephedrineB.PhenylephrineC.TetrahydrozolineD.Xylometazoline

NCLEX

A patient is taking pseudoephedrine. The nurse would assess the patient for which of the following adverse effects?

A.AnxietyB.LethargyC.HypotensionD.Dry skin

NCEX

When describing the effects of antihistamines, which of the following would the nurse address as being decereased?

A.HypersensitivityB.Dry mouthC.Gastrointestinal upsetD.Sedation

NCLEX

A patient is using an inhaled bronchodilator as a treatment of exercise-induced asthma. The nurse would instruct the patient to use the inhaler at which time?

A.Immediately after beginning to exerciseB.15 minutes before engaging in exerciseC.Right before and after exerciseD.Midway during the exercise routine

NCLEX

While reviewing a patient’s history, an allergy to which of the following would alert the nurse to a possible problem with the use of ipratropium?

A.EggsB.DairyC.PeanutsD.Shellfish

NCLEX

A patient is experiencing an acute asthmatic attack. Which agent would be most effective?

A.Inhaled steroidB.Leukotriene receptor antagonistC.Mast cell stabilizerD.Beta-2 selective adrenergic agonist

NCLEX

Milk of Magnesia (MOM) is used to neutralize acid in the stomach. MOM is not indicated for which disease process:

A.HeartburnB.GastritisC.GERDD.Peptic ulcer disease

NCLEX

Once H. pylori is detected in patients with a peptic ulcer, the normal procedure is to: (select all that apply)

A.Administer Prilosec (omeprazole)B.Administer Prevacid (lansoprazole)C.Administer Cleocin (clindamycin)D.Administer Biaxin (clarithromycin)

NCLEX

A patient is admitted with suspected liver disease. The nurse would anticipate which of the following labs to be ordered (select all that apply):

A.LipaseB.LFT’sC.Blood coagulation timesD.electrolytes

NCLEX

General side effects seen in patients taking anti-emetic agents are: (select all that apply)

A.DrowsinessB.ConfusionC.DepressionD.hypotension

NCLEX

A nurse is doing patient teaching to a patient experiencing heartburn. The patient states that he currently smokes approx. 20 cigarettes per day. The nurse would want to educate the patient on which gastrointestinal disorder:A.PUDB.GERDC.H. pyloriD.Gastritis

NCLEX

Which of the following is the most effective class of drugs used to treat diarrhea?

a.Phenothiazinesb.Antihistaminesc.Anticholinergicsd.Opioids

NCLEX

Which class of drugs acts by neutralizing stomach acid?

a.H2-receptor blockersb.Serotonin receptor blockersc.Proton-pump inhibitorsd.antacids

NCLEX

The nurse would administer amoxicillin (Amoxil) or clarithromycin (Biaxin) for peptic ulcers in order to:


NCLEX

Which of the following best describes the mechanism of the action of sucralfate (Carafate)?


vnrs b50a-advanced pharmacology part a

Documents

class print

additional notes

websitebring lecture

history of peptic ulcers

peptic ulcer disease

liver disease

gastric mucosa

hepatic disease